Objective: To evaluate the efficacy of single dose intramuscular methotrexate in the treatment of ectopic pregnancy. Material and Methods: 32 patients who matched the inclusion criteria were enrolled. Success of treatment was defined as a resolution of ectopic pregnancy without performing surgical intervention. The cases in whom the treatment was successful and those that were not were compared for β-hCG values and clinical features. Results: β-hCG at diagnosis averaged 1293.9 mIU/ml. Of the 32 patients who received methotrexate, 26 were successfully treated. 23 patients (71.8%) received a single dose of methotrexate, 3 patients (9.3%) received an additional dose of methotrexate, 6 patients (18.7%) who had failed methotrexate required surgery for cure. The success rate of single-dose methotrexate was 79.3%. Conclusion: Our study shows that single dose systemic methotrexate treatment can be used as an option in unruptured pregnancies.
Tay JI, Moore J, Walker JJ. Ectopic Pregnancy: British Medical Journal 2000;320:916-9.
Lipscomb GH, Stovall TG, Ling FW. Nonsurgical treatment of ec- topic pregnancy. New Eng J Med. 2000;343:1325-9.
Lipscomb GH, Bran D, Ling FW. Analysis of three hundred fifteen ectopic pregnancies treated with single dose Methotrexate. Am J Obstet Gynecol 1998;78:1354-8.
Stovall TG, Ling FW and Gray LA. Single-dose methotrexate for treatment of ectopic pregnancy. Obstet Gynecol 1991;77:754-7.
Glock JL, Johnson JV, Brumsted JR. Efficacy and safety of single- dose methotrexate in the treatment of ectopic pregnancy. Fertil Steril 1994;62:716-21.
Buster JE, Pisarska MD. Medical management of ectopic preg- nancy. Clin Obstet Gynecol 1999;42:23-30.
Dudley PS, Heard MJ, Sangi-Haghpeykar H, Carson SA, Buster JE. Characterizing ectopic pregnancies that rupture despite treatment with methotrexate. Fertil Steril 2004;82:1374-8.
Lispcomb GH, Givens VA, Meyer NL, Bran D. Previous ectopic pregnancy as a predictor of failure of systemic methotrexate therapy. Fertil Steril 2004;81:1221-4.
Takacs P, Rodriguez L. High folic acid levels and failure of single- dose methotrexate treatment in ectopic pregnancy. Int J Gynae- col Obstet 2005;89:301-2.
Takacs P, Chakhtoura N, De Santis T, Verma U. Evaluation of the relationship between endometrial thickness and failure of single- dose methotrexate in ectopic pregnancy. Arch Gynecol Obstet 2005;272:269-72.
Bixby S, Tello R, Kuligowska E. Presence of a yolk sac on trans- vaginal sonography is the most reliable predictor of single-dose methotrexate treatment failure in ectopic pregnancy. J Ultra- sound Med 2005;24:591-8.
Gabbur N, Sherer DM, Hellmann M, Abdelmalek E, Phillip P, Abu- lafia O. Do serum beta-human chorionic gonadotrophin levels on day 4 following methotrexate treatment of patients with ectopic pregnancy predict successful single-dose therapy? Am J Perina- tol 2006;23:193-6.
Nowak-Markwitz E, Michalak M, Olejnik M, Spaczynski M. Cutoff value of human chorionic gonadotropin in relation to the num- ber of methotrexate cycles in the successful treatment of ectopic pregnancy. Fertil Steril. 2008;92:1203-7.
da Costa Soares R, Elito J Jr, Camano L. Increment in beta-hCG in the 48-h period prior to treatment: a new variable predictive of therapeutic success in the treatment of ectopic pregnancy with methotrexate. Arch Gynecol Obstet. 2008;278:319-24.
Barnhart KT, Gosman G, Ashby R, Sammel M. The medical man- agement of ectopic pregnancy: a meta-analysis comparing “single dose” and “multidose” regimens. Obstet Gynecol 2003;101:778-84.
van Mello NM, Mol F, Mol BW, Hajenius PJ. Conservative man- agement of tubal ectopic pregnancy. Best Pract Res Clin Obstet Gynaecol. 2009;23:509-18.
Lipscomb GH, Gomez IG, Givens VM, Meyer NL, Bran DF. Yolk sac on transvaginal ultrasound as a prognostic indicator in the treatment of ectopic pregnancy with single-dose methotrexate. Am J Obstet Gynecol. 2009;200:1-4.
Moon MH, Lee YH, Lim KT, Yang JH, Park SH. Outcome predic- tion for treatment of tubal pregnancy using an intramuscular methotrexate protocol. J Ultrasound Med. 2008;27:1461-7.
Single Dose Methotrexate in Treatment of Ectopic Pregnancy: Review of 32 Case
Year 2011,
Volume: 2011 Issue: 1, 10 - 13, 01.01.2011
Tay JI, Moore J, Walker JJ. Ectopic Pregnancy: British Medical Journal 2000;320:916-9.
Lipscomb GH, Stovall TG, Ling FW. Nonsurgical treatment of ec- topic pregnancy. New Eng J Med. 2000;343:1325-9.
Lipscomb GH, Bran D, Ling FW. Analysis of three hundred fifteen ectopic pregnancies treated with single dose Methotrexate. Am J Obstet Gynecol 1998;78:1354-8.
Stovall TG, Ling FW and Gray LA. Single-dose methotrexate for treatment of ectopic pregnancy. Obstet Gynecol 1991;77:754-7.
Glock JL, Johnson JV, Brumsted JR. Efficacy and safety of single- dose methotrexate in the treatment of ectopic pregnancy. Fertil Steril 1994;62:716-21.
Buster JE, Pisarska MD. Medical management of ectopic preg- nancy. Clin Obstet Gynecol 1999;42:23-30.
Dudley PS, Heard MJ, Sangi-Haghpeykar H, Carson SA, Buster JE. Characterizing ectopic pregnancies that rupture despite treatment with methotrexate. Fertil Steril 2004;82:1374-8.
Lispcomb GH, Givens VA, Meyer NL, Bran D. Previous ectopic pregnancy as a predictor of failure of systemic methotrexate therapy. Fertil Steril 2004;81:1221-4.
Takacs P, Rodriguez L. High folic acid levels and failure of single- dose methotrexate treatment in ectopic pregnancy. Int J Gynae- col Obstet 2005;89:301-2.
Takacs P, Chakhtoura N, De Santis T, Verma U. Evaluation of the relationship between endometrial thickness and failure of single- dose methotrexate in ectopic pregnancy. Arch Gynecol Obstet 2005;272:269-72.
Bixby S, Tello R, Kuligowska E. Presence of a yolk sac on trans- vaginal sonography is the most reliable predictor of single-dose methotrexate treatment failure in ectopic pregnancy. J Ultra- sound Med 2005;24:591-8.
Gabbur N, Sherer DM, Hellmann M, Abdelmalek E, Phillip P, Abu- lafia O. Do serum beta-human chorionic gonadotrophin levels on day 4 following methotrexate treatment of patients with ectopic pregnancy predict successful single-dose therapy? Am J Perina- tol 2006;23:193-6.
Nowak-Markwitz E, Michalak M, Olejnik M, Spaczynski M. Cutoff value of human chorionic gonadotropin in relation to the num- ber of methotrexate cycles in the successful treatment of ectopic pregnancy. Fertil Steril. 2008;92:1203-7.
da Costa Soares R, Elito J Jr, Camano L. Increment in beta-hCG in the 48-h period prior to treatment: a new variable predictive of therapeutic success in the treatment of ectopic pregnancy with methotrexate. Arch Gynecol Obstet. 2008;278:319-24.
Barnhart KT, Gosman G, Ashby R, Sammel M. The medical man- agement of ectopic pregnancy: a meta-analysis comparing “single dose” and “multidose” regimens. Obstet Gynecol 2003;101:778-84.
van Mello NM, Mol F, Mol BW, Hajenius PJ. Conservative man- agement of tubal ectopic pregnancy. Best Pract Res Clin Obstet Gynaecol. 2009;23:509-18.
Lipscomb GH, Gomez IG, Givens VM, Meyer NL, Bran DF. Yolk sac on transvaginal ultrasound as a prognostic indicator in the treatment of ectopic pregnancy with single-dose methotrexate. Am J Obstet Gynecol. 2009;200:1-4.
Moon MH, Lee YH, Lim KT, Yang JH, Park SH. Outcome predic- tion for treatment of tubal pregnancy using an intramuscular methotrexate protocol. J Ultrasound Med. 2008;27:1461-7.
Aybatlı, A., Kaptan, P. B., Sayın, N. C., Alicik, M., et al. (2011). Single Dose Methotrexate in Treatment of Ectopic Pregnancy: Review of 32 Case. Balkan Medical Journal, 2011(1), 10-13. https://doi.org/10.5174/tutfd.2009.02161.1
AMA
Aybatlı A, Kaptan PB, Sayın NC, Alicik M, Yüce MA. Single Dose Methotrexate in Treatment of Ectopic Pregnancy: Review of 32 Case. Balkan Medical Journal. January 2011;2011(1):10-13. doi:10.5174/tutfd.2009.02161.1
Chicago
Aybatlı, Aysun, Petek Balkanlı Kaptan, Niyazi Cenk Sayın, Mehmet Alicik, and Mehmet Ali Yüce. “Single Dose Methotrexate in Treatment of Ectopic Pregnancy: Review of 32 Case”. Balkan Medical Journal 2011, no. 1 (January 2011): 10-13. https://doi.org/10.5174/tutfd.2009.02161.1.
EndNote
Aybatlı A, Kaptan PB, Sayın NC, Alicik M, Yüce MA (January 1, 2011) Single Dose Methotrexate in Treatment of Ectopic Pregnancy: Review of 32 Case. Balkan Medical Journal 2011 1 10–13.
IEEE
A. Aybatlı, P. B. Kaptan, N. C. Sayın, M. Alicik, and M. A. Yüce, “Single Dose Methotrexate in Treatment of Ectopic Pregnancy: Review of 32 Case”, Balkan Medical Journal, vol. 2011, no. 1, pp. 10–13, 2011, doi: 10.5174/tutfd.2009.02161.1.
ISNAD
Aybatlı, Aysun et al. “Single Dose Methotrexate in Treatment of Ectopic Pregnancy: Review of 32 Case”. Balkan Medical Journal 2011/1 (January 2011), 10-13. https://doi.org/10.5174/tutfd.2009.02161.1.
JAMA
Aybatlı A, Kaptan PB, Sayın NC, Alicik M, Yüce MA. Single Dose Methotrexate in Treatment of Ectopic Pregnancy: Review of 32 Case. Balkan Medical Journal. 2011;2011:10–13.
MLA
Aybatlı, Aysun et al. “Single Dose Methotrexate in Treatment of Ectopic Pregnancy: Review of 32 Case”. Balkan Medical Journal, vol. 2011, no. 1, 2011, pp. 10-13, doi:10.5174/tutfd.2009.02161.1.
Vancouver
Aybatlı A, Kaptan PB, Sayın NC, Alicik M, Yüce MA. Single Dose Methotrexate in Treatment of Ectopic Pregnancy: Review of 32 Case. Balkan Medical Journal. 2011;2011(1):10-3.